title: Modified laparoscopic splenectomy: a beneficial technique for ABO-incompatible living donor renal transplantation candidates on hemodialysis.
abstract: Advances in laparoscopy have enabled minimally invasive surgical treatment of splenic diseases. Even with these advances, laparoscopic splenectomy in patients on dialysis can be difficult because of tissue fragility due to the underlying renal disease. We report a safe surgical technique for laparoscopic splenectomy in patients on maintenance dialysis that is suitable for use before ABO-incompatible living donor renal transplantation (LDRTx). Between June 1972 and December 2006, a total of 800 patients underwent LDRTx in our department, including 82 patients who underwent ABO-incompatible LDRTx. Between April 2001 and December 2006 we performed laparoscopic splenectomy in 48 hemodialysis patients as a pretreatment before ABO-incompatible LDRTx. Under general anesthesia the operation was performed using a new technique, referred to as the "splenic hilum lump method." We evaluated the surgical outcomes, such as the operative time, amount of blood loss, efficacy, and complications. The mean operative time was 131.6 +/- 38.4 min and mean blood loss was 126 +/- 395 mL. Blood transfusion was required in three patients. All cases had satisfactory kidney function after LDRTx and none developed kidney graft failure due to acute rejection. Almost all patients could walk the day after laparoscopic splenectomy and were satisfied with the cosmetic appearance of the scar after wound healing. The surgical technique we report here can be safely performed on patients with renal failure who require caution because of tissue fragility. Laparoscopic splenectomy is a safe, effective and less invasive operative procedure as a pretreatment for ABO-incompatible LDRTx.
authors.affiliation: Department of Transplant and Endocrine Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan. matsuoka@nagoya2.jrc.or.jp
authors.forename: Susumu
authors.initials: S
authors.lastname: Matsuoka
authors.forename: Kazuharu
authors.initials: K
authors.lastname: Uchida
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Tominaga
authors.forename: Nobuaki
authors.initials: N
authors.lastname: Uno
authors.forename: Syuichi
authors.initials: S
authors.lastname: Simabukuro
authors.forename: Takahisa
authors.initials: T
authors.lastname: Hiramitsu
authors.forename: Norihiko
authors.initials: N
authors.lastname: Goto
authors.forename: Tetsuhiko
authors.initials: T
authors.lastname: Sato
authors.forename: Takaharu
authors.initials: T
authors.lastname: Nagasaka
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Watarai
mesh_terms: D000017:ABO Blood-Group System / Q000276:immunology*; D000328:Adult; D001787:Blood Group Incompatibility / Q000276:immunology / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D007564:Japan; D007676:Kidney Failure, Chronic / Q000276:immunology / Q000601:surgery; D016030:Kidney Transplantation / Q000379:methods*; D010535:Laparoscopy / Q000379:methods; D007902:Length of Stay; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018570:Risk Assessment; D013156:Splenectomy / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D000017:ABO Blood-Group System